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Getting depression clinical practice guidelines right: time for change?

Acta psychiatrica Scandinavica. Supplementum
January 1, 2013
S Kuiper et al. (5 authors)
Journal ArticleReviewHuman Study
Study Details

Study Goal

The researchers aimed to evaluate clinical practice guidelines for depression treatment, focusing on chronobiological interventions like light therapy.

Results Summary

Current guidelines tentatively support light therapy for seasonal affective disorder but lack sufficient evidence for non-seasonal depression. Recommendations are limited by the absence of reliable therapeutic markers for chronotherapeutics.

Population

Patients with seasonal affective disorder and non-seasonal depression.

Effective Dosage

Not specified

Duration

Not specified

Interactions

None mentioned

Extracted Claims (5)
InterventionDirectionEndpointPopulationDosageImpactClaim #
agomelatine
no change
major depression
-
-
is considered as an option
#1
bright light therapy
no change
seasonal affective disorder
-
-
is considered as an option
#2
sleep deprivation
no change
-
-
-
is not routinely recommended
#3
light therapy
no change
seasonal depression
-
-
supports use
#4
chronotherapeutics
no change
non-seasonal depression
-
-
insufficient evidence to support reliance
#5
Abstract

OBJECTIVE: As part of a series of papers ['Chronobiology of mood disorders' Malhi & Kuiper. Acta Psychiatr Scand 2013;128(Suppl. 444):2-15; and 'It's time we managed depression: The emerging role of chronobiology' Malhi et al. Acta Psychiatr Scand 2013;128(Suppl. 444):1] examining chronobiology in the context of depression, this article examines recent western clinical practice guidelines (CPGs) for the treatment of depression with respect to the recommendations they make, in particular as regards chronobiological treatments, and briefly considers the implications of their methodology and approach. METHOD: Five international treatment guidelines, which had been published in the past 5 years, were identified, representing North American and European views. Chosen guidelines were reviewed by the authors, and the relevant recommendations were distributed for discussion and subsequent synthesis. RESULTS: Most current guidelines do not address chronobiology in detail. Chronotherapeutic recommendations are tentative, although agomelatine is considered as an option for major depression and bright light therapy for seasonal affective disorder. Sleep deprivation is not routinely recommended. CONCLUSION: Recommendations are limited by the lack of reliable therapeutic markers for chronotherapeutics. Current evidence supports use of light therapy in seasonal depression, but in non-seasonal depression there is insufficient evidence to support reliance on chronotherapeutics over existing treatment modalities.

Medical Subject Headings (MeSH)
Depressive DisorderHumansPeriodicityPractice Guidelines as Topic
Study Links
Quality Scores
SafetyNot Assessed
Efficacy70/10
Quality80/10
Citation Metrics
Total Citations14
Citations/Year1.2
Relative Citation Ratio0.58
NIH Percentile31.2%
Research Impact Scores
APT Score0.50
Weight Score1.48
Normalized Score0.64
Related Supplements
Getting depression clinical practice guidelines right: time ... | Panacea Index